NANTUCKET, Mass. — Perhaps there is no more affluent place in Massachusetts than Nantucket. The median single-family home price on the island is more than $2 million.

But amid the prosperity is evidence of the state’s opiate problem — which many say is only exacerbated by the wealth and isolation of the island, and the tens of thousands of vacationers who arrive every summer.

‘A Lot Of Opiate Use’ In The Summer

Dr. Tim Lepore is a general surgeon at Nantucket Cottage Hospital, the island’s only hospital. (Deborah Becker/WBUR)

“I think it is dramatic. I think on Nantucket if you go certain places there are lots of needles around,” says Dr. Tim Lepore, a general surgeon at Nantucket Cottage Hospital, the island’s only hospital. He also runs a program to help those addicted to opiates, and prescribes Suboxone to help with withdrawal symptoms.

Lepore says the wealth on Nantucket may actually contribute to the problem.

“You see a 130-foot yacht in the harbor but then you also see people working four jobs to pay the rent,” he says. “The disparities in income are tremendous and I think that that contributes to some of these problems.”

The entire island gears up for the influx of tourists in the summer, when Nantucket’s population grows tenfold. Most officials are concerned that this summer, opiates will be a big issue, given the vacation mentality.

“In the summer, I hate to say it,” Lepore says. “After five o’clock I anticipate everybody is drunk. Half the island goes to AA and the other half should.”

Although there are dozens of AA, or Alcoholics Anonymous, meetings on the island any given week, Lepore says it’s not so anonymous.

“If you’re living in Framingham or you’re living in Brockton, you may not know what your neighbor is up to,” he says. “Out here you pretty much know if your neighbor is taking their meds.”

One 23-year-old — who didn’t want his name used so people wouldn’t know about his problem — has twice left Nantucket for residential substance abuse treatment. He’s been sober for about a month. He grew up on the island and says once the temperatures rise, drugs become prevalent.

“In the summertime there is a lot of opiate use,” he says. “I notice a lot more cocaine, mushrooms, weed, ecstasy — things like that — social drugs.”

He believes the island’s affluence helps fuel the availability of opiates; it’s drug world economics, he says. Dealers can make double — sometimes triple — what they make selling heroin on the mainland, and they’ll front drugs to try to build a customer network.

“Back when I was using a lot I was selling also. I was trying to support my habit,” he says. “I was getting it on the Cape. They know people from Nantucket have money and they know that there are no drugs out here. They’re very willing to work with people.”

‘It Often Feels Like Missionary Work’

Nantucket police are aware of this and are trying to crack down. While they don’t have statistics on only opiate-related arrests, last year there were 14 arrests on the island for drug distribution. Lt. Jerry Adams says by May of this year there were 10 similar arrests.

“Heroin seems to have made a comeback when the prescription pills became more available,” Adams says. “What I”m seeing now is a younger crowd using opiates. It is very pervasive.”

The Nantucket police force doubles in size in the summer, bringing on reserve and special, so-called “community officers” to handle traffic and minor matters. Adams expects this summer officers will also have to deal with what might be a trend: increased crimes such as larceny, especially at construction sites, presumably to pay for drugs.

He says the island’s small-town atmosphere also makes it difficult for police.

Tessandra Pearson is the executive director of Family & Children’s Services of Nantucket, which offers substance abuse counseling. (Deborah Becker/WBUR)

“Some of these officers have grown up with some of these individuals. Now they’re in the position to have to arrest them for drug-related crimes,” Adams says. “Unlike other communities, officers can’t live in the town next to them. They see them at church or in the grocery store. We’re all here together.”

There is no structured substance abuse treatment on Nantucket — no detox or residential treatment center. In the past year, 25 people from Nantucket were taken to Gosnold Treatment Center on Cape Cod, the closest detox facility.

“Someone once told me that moving to Nantucket was like paradise. Well, it often feels like missionary work, where you are giving and giving to a community that needs a lot,” says Tessandra Pearson, the executive director of Family & Children’s Services of Nantucket, which offers private substance abuse counseling and outpatient counseling.

Pearson’s group also operates a crisis hotline. In just one week last month, the hotline received six calls, three involving opiate overdoses.

“We can say we’ve never had a wait-list this long and we haven’t seen crisis popping like this in quite some time,” she says. “With working with the hospital and other nonprofits, it’s a concern for all of us to see this impact such a small community in a big way.”

Pearson is hiring more counselors and trying to expand services in an effort to reduce the impact of the problem, especially this summer.